Influenza Preparedness: A Primary Care Primer

Check out this useful collection of links to important influenza information from the CDC, the NCCC, key clinical journals, and other trusted sources.

“An Influenza Primer: A Tale of Birds, Pigs, and Pandemics,” year-old guest editorial from Consultant Live written by Gregory Rutecki, MD, asks “How can the primary care practitioner answer questions, educate, prepare, and alleviate anxiety?” Rutecki offers “an influenza primer by a professed non-expert” that provides “information, potentially useful to other professionals who are also non-experts.”

Although “Practical Approaches to Influenza for Primary Care Professionals” is no longer offered for CME credit, it can still help primary care physicians to “identify key populations at high risk, and triage those populations for vaccination and other preventive measures; develop a vaccination program, and effectively vaccinate patients for influenza; differentiate flu symptoms from similar presentations, and appropriately counsel patients on treatment options; investigate office systems changes with the potential to improve or enhance vaccination and treatment program, including patient registries; and incorporate new vaccinations and pharmacologic agents for the treatment of influenza.”

Download the updated Influenza Management Guide 2010-2011, written by Mina Matin, MD, and Ronald H. Goldschmidt, MD, for the National HIV/AIDS Clinicians Consultation Center at San Francisco General Hospital in the UCSF Department of Family and Community Medicine. Although the guide was initially developed “to address questions about treating influenza in persons with human immunodeficiency virus infection, the guide remains applicable to primary care physicians for prevention and management of all patients presenting with influenza-like illness.” It provides useful background information on H1N1 and other seasonal flus, diagnostic and treatment pearls, and guidance on special considerations for HIV-positive patients.

“Influenza Overview and Update: 2010-2011,”a CME activity from Clinician Reviews, is designed to “provide clinicians in primary care with the most up-to-date information regarding prevention, diagnosis, and treatment of influenza infection.” It explains the epidemiology and pathophysiology of human influenza infection, describes the clinical signs, symptoms, and complications associated with human influenza infection, identifies high-risk populations, prevention recommendations, and patient education strategies regarding human influenza infection, discusses the clinical utility of diagnostic tests for human influenza infection, and reviews treatment guidelines for patients infected with influenza.

The CDC’s “Guidance for Clinicians on the Use of Rapid Influenza Diagnostic Tests for the 2010-2011 Influenza Season” notes that although rapid influenza diagnostic tests (RIDTs) “can yield results in a clinically relevant time frame,” physicians should be aware that RIDTs “have limited sensitivity to detect influenza virus infection and negative test results should be interpreted with caution given the potential for false negative results.” Review this PDF document for more information on the advantages and disadvantages of RIDTs, guidance on the use of RIDTs in clinical decision making, and re view of factors that can influence RIDT results.

In this podcast, Joe Bresee, MD, discusses “who should be vaccinated against seasonal flu during the 2010-2011 season” and explains “who is at risk for severe illness from the flu and discusses the benefits of vaccination.”

The “Medical Offices and Clinics Pandemic Influenza Planning Checklist” identifies key areas for pandemic influenza planning and can be used by medical practices and clinics to identify the strengths and weaknesses of current planning efforts.

In “A Systematic Review of Clinical Decision Rules for Influenza,” published in Annals of Family Medicine, Mark Ebell, MD, and Anna Afonso “assessed whether multivariate models and clinical decision rules can be used to reliably diagnose influenza” and found that “although influenza is common and an important source of morbidity and mortality, studies of the diagnosis of this infection are largely small, use varied inclusion criteria and reference standards, and do not report their results in a way that would assist clinicians.” They reported that “only simple clinical heuristics, such as the fever and cough rule, and the fever, cough, and acute onset rule, have been prospectively validated. Their sensitivity and specificity varied considerably, however, and it was not possible to calculate summary measures of accuracy for these rules.”

The CDC Seasonal Influenza Information for Health Professionals page offers key information about vaccination, infection control, prevention, treatment, and diagnosis of seasonal influenza. Physicians will find:

• Links to information on influenza diagnostic testing
• Recommendations from the Advisory Committee on Immunization Practices
• Information on dosing and administration, supply, storage, VIS, effectiveness and safety
• Patient education materials to address the 2010-11 flu recommendations

And don't forget to visit the HCPLive Influenza Condition Resources page and the HCPLive Vaccination Condition Resources page for even more influenza news, information, and resources.